Developing haptic caries simulation for dental education

Background: Treating tooth decay (caries), an essential skill for dental students to learn, relies largely on tactile investigation. Most dental schools use plastic or extracted teeth to teach caries removal and cavity design. However, plastic teeth cannot replicate the ‘feel’ of caries, limiting the available practice exercises to manual dexterity rather than cavity design guided by pathology. Virtual haptic simulation is emerging as a viable adjunct to traditional methods, with potential to simulate dental tissues and pathology. Aim: To develop virtual haptic caries simulations, enabling students to practice the tactile and cognitive aspects of caries removal and cavity design in a controlled environment on the Moog Simodont Dental Trainer. Methods: Custom software was written to enable the creation of blocks containing unique variations of caries. Each block was produced with segment data to enable automatic marking of students’ attempts. This caries block generation process enabled the creation of a large library of disparate carious models calling for a unique solution for each case. Results: A library of caries blocks was built. The blocks hold varying shape, depth and amount of caries within a simulated tooth consisting of enamel, dentine and pulp tissue. The design of the block encouraged the user to follow correct clinical protocols to treat the lesion, while preserving the maximum amount of healthy tissue. Conclusions: We present a novel haptic caries simulation encouraging correct clinical technique based on tactile sensation and realistic disease patterns. The exercises provide a safe environment for novice dental students to practice caries removal

An in vitro study into the accuracy of a novel method for recording the mandibular transverse horizontal axis.

OBJECTIVES: To assess the accuracy of a novel, non-invasive method for determining the axis of rotation of articulated dental study casts. METHOD: A 3D structured light scanner was constructed using a projector and two CMOS cameras. Dental stone casts were arbitrarily mounted on an average value articulator. With the teeth together, sets of 10 scans were taken from three different viewpoints. Each scan captured approximately six upper teeth and six lower teeth. The teeth were then propped open, creating 10mm of incisal separation, and the three sets of 10 scans were repeated. From each pair of scans an axis of rotation was calculated using custom software. A total of 900 axes were created this way. The locations of these axes were plotted in sagittal planes located 57.5mm left and right of the midline to represent the position of the temporo-mandibular joints (TMJs). The accuracy of axis location was then assessed. RESULTS: The average radius of error of the individual axes, compared to the real axis, was 2.65 ± 1.01 mm. 61.3% of the axes lay within 3mm of the true axis, and 99.2% of the axes lay within 5mm of the true axis. CONCLUSIONS: The accuracy of this method is clinically acceptable. Further studies are required to confirm the accuracy of the virtual inter-occlusal records at the level of the dentition. Clinical studies are then indicated to determine whether the transverse horizontal axis on a patient can similarly be determined

Translucent zirconia in the ceramic scenario for monolithic restorations: A flexural strength and translucency comparison test

Objective: To compare three different compositions of Yttria-Tetragonal Zirconia Polycrystal (Y-TZP) ceramic and a lithium disilicate ceramic in terms of flexural strength and translucency. Methods: Three zirconia materials of different composition and translucency, Aadva ST [ST], Aadva EI [EI] and Aadva NT [NT](GC Tech, Leuven, Belgium) were cut with a slow speed diamond saw into beams and tabs in order to obtain, after sintering, dimensions of 1.2 × 4.0 × 15.0 mm and 15.0 × 15.0 × 1.0 mm respectively. Blocks of IPS e.max CAD LT were cut and crystallized in the same shapes and dimensions and used as a reference group [LD]. Beams (n = 15) were tested in a universal testing machine for three-point bending strength. Critical fracture load was recorded in N, flexural strength (σ in MPa), Weibull modulus (m) and Weibull characteristic strength (σ0 in MPa) were then calculated. Tabs (n = 10) were measured with a spectrophotometer equipped with an integrating sphere. Contrast Ratios were calculated as CR = Yb/Yw. SEM of thermally etched samples coupled with lineal line analysis (n = 6) was used to measure the tested zirconia grain size. Data were statistically analyzed. Results: Differences in translucency, flexural strength and grain size were found to be statistically significant. CR increased and flexural strength decreased in the following order ST(σ 1215 ± 190 MPa, CR 0.74 ± 0.01) > EI(σ 983 ± 182 MPa, CR 0.69 ± 0.01) > NT(σ 539 ± 66 MPa, CR 0.65 ± 0.01) > LD (σ 377 ± 39 Mpa, CR 0.56 ± 0.02). The average grain size was different for the three zirconia samples with NT(558 ± 38 nm) > ST(445 ± 34 nm) > EI(284 ± 11 nm). Conclusions: The zirconia composition heavily influenced both the flexural strength and the translucency. Different percentages of Yittria and Alumina result in new materials with intermediate properties in between the conventional zirconia and lithium disilicate. Clinical indications for Zirconia Aadva NT should be limited up to three-unit span bridges

Dynamics of multi-stage infections on networks

This paper investigates the dynamics of infectious diseases with a nonexponentially distributed infectious period. This is achieved by considering a multistage infection model on networks. Using pairwise approximation with a standard closure, a number of important characteristics of disease dynamics are derived analytically, including the final size of an epidemic and a threshold for epidemic outbreaks, and it is shown how these quantities depend on disease characteristics, as well as the number of disease stages. Stochastic simulations of dynamics on networks are performed and compared to output of pairwise models for several realistic examples of infectious diseases to illustrate the role played by the number of stages in the disease dynamics. These results show that a higher number of disease stages results in faster epidemic outbreaks with a higher peak prevalence and a larger final size of the epidemic. The agreement between the pairwise and simulation models is excellent in the cases we consider

Persistence in epidemic metapopulations: quantifying the rescue effects for measles, mumps, rubella and whooping cough

Metapopulation rescue effects are thought to be key to the persistence of many acute immunizing infections. Yet the enhancement of persistence through spatial coupling has not been previously quantified. Here we estimate the metapopulation rescue effects for four childhood infections using global WHO reported incidence data by comparing persistence on island countries vs all other countries, while controlling for key variables such as vaccine cover, birth rates and economic development. The relative risk of extinction on islands is significantly higher, and approximately double the risk of extinction in mainland countries. Furthermore, as may be expected, infections with longer infectious periods tend to have the strongest metapopulation rescue effects. Our results quantitate the notion that demography and local community size controls disease persistence

Outcome measures in facial prosthesis research: a systematic review

Statement of problem Facial prosthesis research uses a wide variety of outcome measures, which results in challenges when comparing the effectiveness of interventions among studies. Consensus is lacking regarding the most appropriate and meaningful outcome measures to use in facial prosthesis research to capture important perspectives. Purpose The purpose of the systematic review was to identify and synthesize outcome measures used in facial prosthesis research. Material and methods Electronic searches were performed in 11 databases (including nonpeer-reviewed literature). The citations were searched, and expert societies were contacted to identify additional studies. Inclusion criteria comprised studies of participants with facial defects who required or had received prosthetic rehabilitation with an external facial prosthesis. Exclusion criteria comprised participants with ocular prostheses, case reports, case series with fewer than 5 participants, laboratory-based studies, and studies published before 1980. Study selection was performed independently by 2 reviewers. Discrepancies were resolved through discussion or by a third reviewer. Outcome measures were synthesized with a categorization approach based on the perspective, theme, and subtheme of the outcome measures. Quality assessment was performed with an appraisal tool that enabled evaluation of studies with diverse designs. Results Database searching identified 13 058 records, and 7406 remained after duplications were removed. After initial screening, 189 potentially relevant records remained, and 186 full texts were located (98% retrieval rate). After full-text screening, 124 records were excluded. Citation searches and contact with expert societies identified 4 further records. In total, 69 articles (grouped into 65 studies) were included. Studies were categorized as per the perspective of their outcome measures, with the following findings: patient-reported (74% of studies), clinical indicators (34%), clinician-reported (8%), multiple viewpoints (6%), and independent observer-reported (3%). Patient-reported outcome measures included tools to assess satisfaction, quality of life, and psychologic health. Variability in the choice of outcome measures was evident among the studies, with many self-designed, unvalidated, condition-specific questionnaires reported. A greater number of outcome measure themes emerged over time; themes such as service delivery and health state utility have recently been evaluated. Conclusions Over the past 40 years, facial prosthesis research has focused on patient-reported outcome measures. Outcome measures relating to other perspectives have been used less frequently, although new themes appear to be emerging in the literature. Future research should use outcome measures with appropriate measurement properties for use with facial prosthetics

Epidemics on contact networks: a general stochastic approach

Dynamics on networks is considered from the perspective of Markov stochastic processes. We partially describe the state of the system through network motifs and infer any missing data using the available information. This versatile approach is especially well adapted for modelling spreading processes and/or population dynamics. In particular, the generality of our systematic framework and the fact that its assumptions are explicitly stated suggests that it could be used as a common ground for comparing existing epidemics models too complex for direct comparison, such as agent-based computer simulations. We provide many examples for the special cases of susceptible-infectious-susceptible (SIS) and susceptible-infectious-removed (SIR) dynamics (e.g., epidemics propagation) and we observe multiple situations where accurate results may be obtained at low computational cost. Our perspective reveals a subtle balance between the complex requirements of a realistic model and its basic assumptions.Comment: Main document: 16 pages, 7 figures. Electronic Supplementary Material (included): 6 pages, 1 tabl

Numerical Integration of the Master Equation in Some Models of Stochastic Epidemiology

The processes by which disease spreads in a population of individuals are inherently stochastic. The master equation has proven to be a useful tool for modeling such processes. Unfortunately, solving the master equation analytically is possible only in limited cases (e.g., when the model is linear), and thus numerical procedures or approximation methods must be employed. Available approximation methods, such as the system size expansion method of van Kampen, may fail to provide reliable solutions, whereas current numerical approaches can induce appreciable computational cost. In this paper, we propose a new numerical technique for solving the master equation. Our method is based on a more informative stochastic process than the population process commonly used in the literature. By exploiting the structure of the master equation governing this process, we develop a novel technique for calculating the exact solution of the master equation – up to a desired precision – in certain models of stochastic epidemiology. We demonstrate the potential of our method by solving the master equation associated with the stochastic SIR epidemic model. MATLAB software that implements the methods discussed in this paper is freely available as Supporting Information S1

A qualitative study exploring midlife women’s stages of change from domestic violence towards freedom

Gold OABackground Domestic Violence (DV) remains a significant global health problem for women in contemporary society. Existing literature on midlife women’s experiences of domestic violence is limited and focuses on health implications. Leaving a violent relationship is a dynamic process that often requires multiple attempts and separations prior to final termination. The aim of this study was to explore the process of leaving a violent relationship for midlife women. Methods This qualitative study involved fifteen women aged between 40–55 who had accessed residential and non-residential community support services for domestic violence within the UK. Community-based support agencies provided these women with access to letters of invitation and participant information sheet explaining the study. The women notified agency staff who contacted the research team to arrange a mutually convenient time to meet within a safe place for both the women and researchers. It was stressed to all potential participants that no identifiable information would be shared with the agency staff. Women were considered survivors of DV if they defined themselves as such. Data were gathered through semi structured interviews, transcribed verbatim and thematically analysed. Results Midlife women appear to differ from younger women by transitioning quickly though the stages of change, moving rapidly through the breaking free onto the maintenance stage. This rapid transition is the resultant effect of living with long-term violence causing a shift in the women’s perception towards the violent partner, with an associated reclamation of power from within the violent relationship. A realisation that rapid departure from the violence may be critical in terms of personal safety, and the realisation that there was something ‘wrong’ within the relationship, a ‘day of dawning’ that had not been apparent previously appears to positively affect the trajectory of leaving. Conclusions Midlife women appeared to navigate through the stages of change in a rapid linear process, forging ahead and exiting the relationship with certainty and without considering options. Whilst these findings appear to differ from younger women’s process of leaving, further research is needed to explore and understand the optimum time for intervention and support to maximise midlife women’s opportunities to escape an abusive partner, before being reflected appropriately in policy and practice.This study received funding from The Research and Knowledge Transfer Office, The University of Chester, and from the Western Australian Health Promotion Foundation – ‘Healthway

Functional Locomotor Consequences of Uneven Forefeet for Trot Symmetry in Individual Riding Horses

ABSTRACT: Left-right symmetrical distal limb conformation can be an important prerequisite for a successful performance, and it is often hypothesized that asymmetric or uneven feet are important enhancing factors for the development of lameness. On a population level, it has been demonstrated that uneven footed horses are retiring earlier from elite level competition, but the biomechanical consequences are not yet known. The objectives of this study were to compare the functional locomotor asymmetries of horses with uneven to those with even feet. Hoof kinetics and distal limb kinematics were collected from horses (n = 34) at trot. Dorsal hoof wall angle was used to classify horses as even or uneven (1.5° difference between forefeet respectively) and individual feet as flat (55°). Functional kinetic parameters were compared between even and uneven forefeet using MANOVA followed by ANOVA. The relative influences of differences in hoof angle between the forefeet and of absolute hoof angle on functional parameters were analysed using multiple regression analysis (P<0.05). In horses with uneven feet, the side with the flatter foot showed a significantly larger maximal horizontal braking and vertical ground reaction force, a larger vertical fetlock displacement and a suppler fetlock spring. The foot with a steeper hoof angle was linearly correlated with an earlier braking-propulsion transition. The conformational differences between both forefeet were more important for loading characteristics than the individual foot conformation of each individual horse. The differences in vertical force and braking force between uneven forefeet could imply either an asymmetrical loading pattern without a pathological component or a subclinical lameness as a result of a pathological development in the steeper foot